Twelve biofeedback treatments in a 90 day period will be authorized for the conditions listed above when an evaluation report is submitted documenting:

The basis for the worker's condition, or

The condition's relationship to the industrial injury, or

An evaluation of the worker’s current functional measurable modalities (for example, range of motion, up time, walking tolerance, medication intake), or

An outline of the proposed treatment program, or

An outline of the expected restoration goals.

No further biofeedback treatments will be authorized or paid for without substantiation of evidence of improvement in measurable, functional modalities (for example, range of motion, up time, walking tolerance, medication intake). Also:

Only one additional treatment block of 12 treatments per 90 days will be authorized, and

Requests for biofeedback treatment beyond 24 treatments or 180 days will be granted only after file review by and on the advice of the department's medical consultant.

In addition to treatment, pretreatment and periodic evaluation will be authorized. Follow-up evaluation can be authorized at one, three, six, and 12 months post treatment.

Home biofeedback device rentals are time limited and require prior authorization.

Note: Performance and billing of NCS (including SSEP and H-reflex testing) and EMG that consistently falls outside of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) recommended number of tests may be reviewed for quality and whether it is “proper and necessary.” Also see "Example: Reasonable limits on units required to determine a diagnosis," below.

Qualified PT providers may bill for the technical and professional portion of the nerve conduction and electromyography tests performed.

Services that aren’t covered

Electrodiagnostic testing isn’t covered when:

It isn’t proper and necessary (see “Note” and “Link,” below this list), or

Performed in a mobile diagnostic lab in which the specialist physician isn’t present to examine and test the patient, or

Billing of the technical and professional portions of the codes may be separated. However, the physician billing for interpretation and diagnosis (professional component) must have direct contact with the patient at the time of testing.

Note: The department may recoup payments made to a provider, plus interest, for NCS and EMG tests paid inappropriately.

Example: Reasonable limits on units required to determine a diagnosis

The table below was developed by the AANEM and summarizes reasonable limits on units required, per diagnostic category, to determine a diagnosis 90% of the time.

Note:Note: As mentioned under “Services that can be billed” (above), review of the quality and appropriateness (whether the test is “proper and necessary”) may occur when testing repeatedly exceeds AANEM recommendations.

Recommended maximum number of studies by indication (from “AANEM Table 1”; recreated and adapted with written permission from AANEM):